What is the treatment for a parotid gland infection?

Treatment of Parotid Gland Infection

The treatment for parotid gland infection should include hydration, antibiotic therapy directed against Staphylococcus aureus and anaerobic bacteria, and stimulation of salivary flow as first-line management. 1, 2, 3

Types of Parotid Infections

Acute Bacterial Parotitis

• Most commonly caused by:
  • Staphylococcus aureus (predominant pathogen)
  • Streptococcus species
  • Anaerobic bacteria (Peptostreptococcus, Bacteroides, Prevotella species)
  • Gram-negative bacteria (especially in hospitalized patients)

Viral Parotitis

• Common causative agents:
  • Paramyxovirus (mumps)
  • Epstein-Barr virus
  • Coxsackievirus
  • Influenza and parainfluenza viruses

Chronic/Recurrent Parotitis

• Often related to ductal abnormalities or obstruction
• May require different management approach than acute cases

Treatment Algorithm

Step 1: Initial Management (All Parotid Infections)

• Ensure adequate hydration (critical first step)
• Warm compresses to the affected area
• Salivary stimulation:
  • Sialagogues (lemon drops, sugar-free candies)
  • Gentle massage of the gland

Step 2: Antimicrobial Therapy for Bacterial Parotitis

• Empiric antibiotic therapy should cover both aerobic and anaerobic bacteria 1, 2:

  • First-line: Anti-staphylococcal penicillin (e.g., oxacillin, nafcillin) or first-generation cephalosporin
  • For penicillin-allergic patients: Clindamycin
  • For severe cases or hospitalized patients: Consider broader coverage with piperacillin-tazobactam or ampicillin-sulbactam
  • Duration: 7-10 days typically required

• Adjust antibiotics based on culture and sensitivity results when available

Step 3: Management of Complications or Severe Cases

• Surgical drainage indicated when:

  • Abscess formation is evident
  • No response to medical therapy within 48-72 hours
  • Worsening symptoms despite appropriate antibiotics

• Surgical approach:

  • Incision and drainage for localized abscess
  • In rare severe cases, formal parotidectomy may be required for chronic recurrent parotitis unresponsive to conservative measures 4

Special Considerations

For Viral Parotitis (e.g., Mumps)

• Supportive care is the mainstay of treatment:
  • Adequate hydration
  • Pain control with acetaminophen or NSAIDs
  • Rest
• Isolation measures to prevent spread (especially important in mumps)
• No specific antiviral therapy is typically indicated

For Chronic/Recurrent Parotitis

• Conservative management initially:
  • Hydration
  • Sialagogues
  • Warm compresses
  • Prophylactic antibiotics during acute exacerbations
• Diagnostic imaging (ultrasound, sialography) may be both diagnostic and therapeutic 5
• For persistent cases:
  • Sialendoscopy with ductal irrigation
  • Parotid duct ligation or parotidectomy for severe refractory cases 4

Predisposing Factors to Address

• Dehydration (most common)
• Medications that reduce salivary flow (anticholinergics, antihistamines)
• Poor oral hygiene
• Malnutrition
• Ductal obstruction (stones, strictures)
• Immunosuppression

Monitoring and Follow-up

• Daily assessment of:
  • Pain levels
  • Swelling
  • Fever resolution
  • Ability to open mouth
• Follow-up within 1 week to ensure resolution
• Consider further investigation for recurrent cases:
  • Ultrasound
  • Sialography
  • Culture of any drainage

Prevention of Recurrence

• Maintain adequate hydration
• Good oral hygiene
• Regular dental check-ups
• Consider mumps vaccination if not previously immunized
• Management of underlying conditions that predispose to parotitis